Editorial: Extreme demand

Wednesday

Jun 29, 2011 at 12:01 AMJun 29, 2011 at 10:03 AM

The United States faces a daunting shortage of doctors, a problem that President Barack Obama's health-care overhaul would critically exacerbate as it seeks to provide 32 million additional people with health insurance.

The United States faces a daunting shortage of doctors, a problem that President Barack Obama's health-care overhaul would critically exacerbate as it seeks to provide 32 million additional people with health insurance. That total includes 16 million expected to sign up for Medicaid, the federal health-care program for the poor.

Officials are recruiting "mystery shoppers" to pose as patients who phone doctors and see how difficult it is to get an appointment. The stealth survey also seeks to determine whether doctors favor patients with private insurance and turn away those with government-reimbursed health care, which pays doctors less than the cost of providing the care.

"Is this a good use of tax money? Probably not," Dr. Robert L. Hogue, a family physician in Texas, told the New York Times. "Everybody with a brain knows we do not have enough doctors."

It also is well-established that many doctors already limit the number of patients whose health-care is paid for by the government.

The real problem is that the issue of doctor supply should have been studied before the health-care overhaul mandated a huge increase in demand, not after.

But this law was never about sound policy. It was about politics and presidential bragging rights. A Democratic congressional majority used a moment of dominance to impose a hugely expensive and widely opposed new social program on the nation. The president saw it as the keystone of his legacy.

Though the results of the overdue patient-access study are predictable, what the administration will do with them is not. The Patient Protection and Affordable Care Act hinges on having enough doctors to treat the newly insured. Otherwise, people will continue to seek care in hospital emergency rooms, the most expensive option.

Solutions are limited:

• Train more doctors. This cannot be done overnight, and certainly not before Obamacare becomes operational in 2014. Physicians complete four years of college, three years of medical school and three to eight years of residency training.

• Increase Medicaid and Medicare reimbursement rates to give doctors a greater incentive to take the flood of patients Obamacare will enroll. That would cause costs to skyrocket, further discrediting the White House's already-bogus claims of savings from the health-care overhaul.

• Require or pressure doctors to accept patients. This would be the most Draconian solution, but hardly outside the realm of possibility. Obama already claims the power to compel Americans to buy health-care insurance on the grounds that the program only works if all participate. It would be a short step to require doctors to provide care under the same rationale.

The Association of American Medical Colleges projects Obamacare will worsen physician shortages by more than 50 percent, starting in 2015. By 2020, the nation will be short 45,000 primary-care physicians and 46,000 surgeons and specialists.

"The United States already was struggling with a critical physician shortage," the association says. "And the problem will only be exacerbated as 32 million Americans acquire health-care coverage, and an additional 36 million people enter Medicare."

The survey is yet more proof that this half-baked, wholesale restructuring of the American health-care system should not have been rushed, behind closed doors, by politicians with no input from those on the front lines of health care.

Further straining the situation is that baby boomers are aging, and the need for specialists will increase. But doctors also are aging, the association says: "Nearly one-third of all physicians will retire in the next decade, just as more Americans need care."

It doesn't take a brain surgeon - if one is available - to see that trouble lies ahead.

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